Reports

10 pages, 3671 KiB

Open AccessCase Report

Long-Term Survival of Patients with Adult T-Cell Leukemia/Lymphoma Treated with Amplified Natural Killer Cell Therapy

by Yuji Okubo, Sho Nagai, Yuta Katayama, Kunihiro Kitamura, Kazuhisa Hiwaki and Keisuke Teshigawara

Reports 2024, 7(3), 80; https://doi.org/10.3390/reports7030080 - 19 Sep 2024

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Abstract

Background: Adult T-cell leukemia/lymphoma (ATL) is caused by human T-cell leukemia virus type 1 (HTLV-1) after a long latent infection. HTLV-1 induces the indolent or aggressive type of leukemia in 5% of HTLV-1 carriers. ATL, especially the aggressive type, is resistant to multi-agent [...] Read more.

Background: Adult T-cell leukemia/lymphoma (ATL) is caused by human T-cell leukemia virus type 1 (HTLV-1) after a long latent infection. HTLV-1 induces the indolent or aggressive type of leukemia in 5% of HTLV-1 carriers. ATL, especially the aggressive type, is resistant to multi-agent chemotherapy. The indolent type often progresses to the aggressive type. Even in the most indolent-type cases, that is, smoldering ATL, the average survival time is 55.0 months. Case Presentation: Five patients with ATL were followed up for their clinical course after amplified natural killer cell (ANK) therapy. Four patients who received ANK therapy as first-line therapy achieved complete remission and showed long-term survival without aggressive conversion or relapse for more than 5 years. One patient was treated with multiagent chemotherapy due to acute exacerbation but relapsed 2 months later. She was subsequently treated with radiation and ANK therapy and survived for more than 6 years. Furthermore, ANK therapy enhanced the immune function of ATL patients to a level higher than that of normal individuals. Conclusions: ANK therapy has great potential as first-line treatment for ATL. Full article

(This article belongs to the Section Oncology)

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ANK therapy and overall survival. Light blue bars: time from clinical diagnosis to initiation of ANK therapy. Yellow bars: time from initiation of ANK therapy to death or last follow-up day (September 2020). Red bars: duration of ANK therapy. Small numbers: number of intravenous injections of ANK cells. Full article ">Figure 2
Fluctuation of serum sIL-2R levels in Patient 2 (blue broken line). Serum levels of sIL-2R before ANK therapy. Patient 2 developed acute exacerbation and was treated with multi-agent chemotherapy. She had CR, and her serum sIL-2R levels decreased to 1018 U/mL. However, her ATL relapsed two months later. Full article ">Figure 3
Fluctuation of serum sIL-2R levels in Patient 1 with ANK therapy after acute exacerbation of smoldering ATL. Reprinted/adapted with permission from Ref. [<a href="#B13-reports-07-00080" class="html-bibr">13</a>]. Copyright 2018, copyright Dr. Keisuke Teshigawara. Full article ">Figure 4
The level of serum sIL-2R in patients receiving ANK therapy as first-line treatment. Serum sIL-2R levels in the patients who received ANK therapy as first-line treatment and their status of watchful waiting. Full article ">Figure 5
Changes in serum sIL-2R levels in patient 2. Two months after the introduction of ANK therapy, ATL recurred and skin tumors appeared frequently. Radiotherapy was administered until the seventh course of ANK therapy, but then ANK therapy alone was administered for the next 9 months, and serum sIL-2R levels decreased. Full article ">Figure 6
The effect of conventional and ANK therapies on the clinical course of Patient 2. Healing of multiple skin tumor and reduction in serum sIL-2R in Patient 2. Patient 2 relapsed and showed multiple skin tumors on her left forearm (Photo 1). These skin tumors were almost cured seven months after ANK therapy (Photo 2). Thereafter, the healthy status of the left forearm continued for five years (Photo 3). Full article ">Figure 7
Comparison of NK cell activity between patents achieved complete remission and healthy controls (n = 20). Yellow line: Patient 4, red line: Patient 5. Full article ">

11 pages, 218 KiB

Open AccessArticle

Airway Management and General Anesthesia in Pediatric Patients with Special Needs Undergoing Dental Surgery: A Retrospective Study

by Alessandra Ciccozzi, Ettore Lupi, Stefano Necozione, Filippo Giovannetti, Antonio Oliva, Roberta Ciuffini, Chiara Angeletti, Franco Marinangeli and Alba Piroli

Reports 2024, 7(3), 79; https://doi.org/10.3390/reports7030079 - 17 Sep 2024

Cited by 1 | Viewed by 748

Abstract

Background: The definition of patients with special needs (SNs) is used in the literature to refer to individuals with mental and physical disorders for whom the usual perioperative pathways are not applicable due to lack of cooperation, regardless of age. Studies in the [...] Read more.

Background: The definition of patients with special needs (SNs) is used in the literature to refer to individuals with mental and physical disorders for whom the usual perioperative pathways are not applicable due to lack of cooperation, regardless of age. Studies in the literature recognize the appropriateness of general anesthesia for performing day surgery dental care in this type of patient. Objectives: The main objective was to assess the possible incidence of difficult airway management, understood as difficulty ventilating and/or intubating the patient. A secondary objective was to highlight the influence of general anesthesia on patient outcomes by testing the incidence of perioperative complications. Methods: The present retrospective, single-center, observational study involved 41 uncooperative patients aged between 3 and 17 undergoing dental surgery under general anesthesia. Data relating to airway management and general anesthesia present in the medical records were analyzed. Results: Tracheal intubation was successfully completed in all of the patients considered, and in no case did the patient have to be woken up because of difficulty in airway management. No perioperative complications attributable to anesthesia were found in any patients. Conclusions: From the present experience, it can be concluded that general anesthesia is a suitable option for performing dental care in pediatric subjects with special needs, and that although the peculiar perioperative management of these patients might increase the risk of possible anesthesia-related side effects, no complications have been encountered in any case. Full article

(This article belongs to the Special Issue Clinical Research on Oral Diseases)

10 pages, 414 KiB

Open AccessArticle

Association between Thyroid Profile Levels and Lymph Node Metastasis in Papillary Thyroid Carcinoma: A Retrospective Study

by Yu-Shan Hsieh, Ting-Teng Yang, Chung-Huei Hsu and Yan-Yu Lin

Reports 2024, 7(3), 78; https://doi.org/10.3390/reports7030078 - 16 Sep 2024

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Abstract

Background: Thyroid cancer is the most common endocrine carcinoma, accounting for 3.26% of all cancers. The most histologically, well-differentiated thyroid cancer is papillary thyroid carcinoma (PTC). Although PTC is regarded as an indolent tumor, a portion of the cancer cells metastasize to lymph [...] Read more.

Background: Thyroid cancer is the most common endocrine carcinoma, accounting for 3.26% of all cancers. The most histologically, well-differentiated thyroid cancer is papillary thyroid carcinoma (PTC). Although PTC is regarded as an indolent tumor, a portion of the cancer cells metastasize to lymph nodes around the thyroid gland. Lymph node metastasis (LNM) is a critical risk factor for tumor recurrence in PTC, which strongly affects disease prognosis and the quality of life. Methods: This study aims to examine how differences in the level of the thyroid profile and other risk factors may influence LNM incidence in patients with PTC in Taiwan. We carried out a single-center retrospective study. These PTC patients were retrospectively reviewed by the Department of Endocrinology from 2016 to 2019. A total of 165 patients were included in our research. Results: The findings revealed a close relationship with the level of free thyroxine (FT4), the level of the thyroid-stimulating hormone (TSH), and lymph node metastases. The correlation in terms of FT4 (p = 0.005) and TSH (p = 0.417) with LNM was found as a result of the univariate regression analysis. In the multiple regression analysis, the findings revealed a close relationship between LNM, FT4 (p < 0.001), and TSH (p = 0.008). Conclusions: Although the predictability of the TSH should be examined further, the association between LNM and FT4 or TSH should not be ignored. The results could help guide decision-making and patient counseling, using the level of serum FT4 or the TSH as a possible predictive factor of the LNM in PTC. Full article

(This article belongs to the Section Endocrinology/Metabolism)

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12 pages, 1258 KiB

Open AccessArticle

Cancer Stem Cell Marker CD147 Expression in Erosive Oral Lichen Planus Compared to Moderately and Severely Dysplastic Leukoplakia

by Vasileios Zisis, Nikolaos Nikitas Giannakopoulos, Athanasios Poulopoulos, Marc Schmitter and Dimitrios Andreadis

Reports 2024, 7(3), 77; https://doi.org/10.3390/reports7030077 - 15 Sep 2024

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Abstract

Oral lichen planus is a frequent, chronic autoimmune disease that affects the oral mucosa and is characterized as an oral potentially malignant disorder. The aim of our study is to examine the presence of CSCs bearing CD147 (a marker related to local inflammation [...] Read more.

Oral lichen planus is a frequent, chronic autoimmune disease that affects the oral mucosa and is characterized as an oral potentially malignant disorder. The aim of our study is to examine the presence of CSCs bearing CD147 (a marker related to local inflammation and associated with various cancers) through immunohistochemistry in oral lichen planus (OLP) compared to oral leukoplakia (OL) and healthy tissues. These findings could contribute to clinical practice by providing a marker for the prognostic assessment of OLP lesions with regards to their potentially malignant nature. The study sample consisted of paraffin-embedded oral mucosa specimens from the archives of the Department of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki, Greece during the period 2009–2019. The study sample contained 24 cases of OLP (14 erosive and 10 reticular) and 30 cases of oral leukoplakia, which were compared to 5 normal oral epithelium samples derived from healthy epithelium adjacent to fibromas from other cases. Cell membrane staining of CD147 was observed mostly in the basal and parabasal cell layer. The statistically significantly higher expression of CD147 in the erosive lichen planus subgroup than in the moderately and severely dysplastic leukoplakia subgroup (p = 0.01) constituted the most important finding of this study. The characteristic expression of CD147 in erosive OLP suggests the presence of epithelial cells with CSC characteristics, but its lower expression in oral leukoplakias suggests a more intense relation of the CD147 marker with inflammation rather than with oral dysplastic progression. Full article

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Difference between A1 and B2 regarding CD147. On the y-axis, the number of the samples, stained for CD147, per category is depicted. The categories are A1 (reticular lichen planus, dark blue) and B2 (mildly dysplastic and non-dysplastic leukoplakia, gray). On the x-axis, category 1 represents the score of the samples (all of them were scored as 1). Full article ">Figure 2
Differences among A, B, D, A1, A2, B1 and B2 regarding CD147. On the y-axis, the number of samples, stained for CD147, per category is depicted. The upper right statistical categories correspond to A (lichen planus, light blue), B (leukoplakia, red), D (normal oral epithelium, yellow), A1 (reticular lichen planus, dark blue), A2 (erosive lichen planus, pink), B1 (moderately and severely dysplastic leukoplakia, mauve) and B2 (mildly dysplastic and non-dysplastic leukoplakia, gray). On the x-axis, category 0 represents the samples scored with 0, category 1 represents the samples scored with 1 and category 2 represents the samples scored with 2. (A): Comparison between lichen planus and leukoplakia. (B): The comparison between lichen planus and normal oral epithelium. (C): Comparison between reticular lichen planus and erosive lichen planus. (D): Comparison between reticular lichen planus and moderately and severely dysplastic leukoplakia. (E): Comparison between erosive lichen planus and moderately and severely dysplastic leukoplakia. (F): Comparison between erosive lichen planus and mildly dysplastic and non-dysplastic leukoplakia. Full article ">Figure 3
(A): Membranous staining of CD147 in the lower third of the epithelium (×40) in a case of reticular lichen planus. The blue arrows show the membranous staining of the basal cell layer. The yellow arrows show the membranous staining of the parabasal cell layer. (B): Membranous staining of CD147 in the lower and middle third of the epithelium (×20) in a case of erosive lichen planus. The blue arrows show the membranous staining of the basal cell layer. The blue bracket outlines the positively stained lower and middle third of the epithelium. Full article ">

9 pages, 574 KiB

Open AccessArticle

Prevalence of Cardiotoxicity Secondary to Trastuzumab in Patients with HER-2-Positive Breast Cancer in Southeast Mexico

by Luz I. Pascual-Mathey, Midory I. Velez-Figueroa, Joel J. Díaz-Vallejo, Gustavo Mendez-Hirata and Gustavo F. Mendez-Machado

Reports 2024, 7(3), 76; https://doi.org/10.3390/reports7030076 - 14 Sep 2024

Cited by 1 | Viewed by 688

Abstract

In Mexico, breast cancer (BC) is the principal cause of death in women over 30 years old, with an annual mortality rate of 14.61 deaths per a 100,000 population. Chemotherapy, in combination with trastuzumab (TTZ), improves the survival of cancer patients; however, cardiotoxicity [...] Read more.

In Mexico, breast cancer (BC) is the principal cause of death in women over 30 years old, with an annual mortality rate of 14.61 deaths per a 100,000 population. Chemotherapy, in combination with trastuzumab (TTZ), improves the survival of cancer patients; however, cardiotoxicity (CT) is the principal consequence. CT prevalence occurs between 10% and 30% of patients; however, there are no data about the prevalence of CT in the Mexican population. This study aims to establish the prevalence of CT in patients treated with anti-HER-2 therapy among BC women in southeast Mexico. A retrospective cross-sectional study was carried out from January 2015 to July 2019. The records of 46 patients diagnosed with HER-2-positive BC who attended the Mexican Social Security Institute in the Ambulatory Care Medicine Unit were analyzed. The diagnostic criterion for CT was a decrease in LVEF > 10% from baseline or a final LVEF < 53%. CT prevalence was observed in 19 (41.3%) of women with cancer, with an average decrease in LVEF of 13%. In the population, we found an association between weight, surface area, and the loading dose of TTZ with CT. Nutritional follow-up and the administration of cardioprotective drugs are necessary to recover LVEF and avoid cardiovascular failure in women with BC and survivors. Full article

(This article belongs to the Section Oncology)

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7 pages, 1922 KiB

Open AccessCase Report

Three-Layer Reconstruction of a Full-Thickness Nasal Alar Defect after Basal-Cell Carcinoma Removal

by Kostadin Gigov, Ivan Ginev, Ivaylo Minev and Petra Kavradzhieva

Reports 2024, 7(3), 75; https://doi.org/10.3390/reports7030075 - 9 Sep 2024

Viewed by 692

Abstract

Restoring the integrity of the external nose presents a complex surgical challenge due to its three-dimensional structure and subunit divisions. The most frequent causes of nasal defects include basal or squamous cell carcinoma, animal bites and trauma. The reconstruction approach varies depending on [...] Read more.

Restoring the integrity of the external nose presents a complex surgical challenge due to its three-dimensional structure and subunit divisions. The most frequent causes of nasal defects include basal or squamous cell carcinoma, animal bites and trauma. The reconstruction approach varies depending on factors such as the defect’s size, the affected subunit of the nose, the condition and quality of the surrounding tissues and the surgeon’s expertise. Commonly employed surgical techniques for nasal reconstruction include the forehead flap, nasolabial flap, Rieger flap, bilobed flap, and free autologous skin graft. We present a clinical case of a patient with a full-thickness nasal alar defect who underwent three-layer reconstruction with a combination of an inverted skin flap- for the internal lining, a conchal graft to substitute the missing alar cartilage and a forehead flap for external coverage. One of the challenges of nasal reconstruction surgery is to restore a full-thickness defect, especially the internal nasal lining. We offer a different perspective on this problem, showcasing considerable advantages, as there are limited literature data on this method. Full article

(This article belongs to the Section Surgery)

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15 pages, 1361 KiB

Open AccessArticle

The Relationship between Proinflammatory Molecules and PD-L1 in Patients with Obesity Who Underwent Gastric Sleeve Surgery—A Pilot Study

by Ciprian Cucoreanu, Ximena Maria Muresan, Adrian-Bogdan Tigu, Madalina Nistor, Radu-Cristian Moldovan, Ioana-Ecaterina Pralea, Maria Iacobescu, Cristina-Adela Iuga, Catalin Constantinescu, George-Calin Dindelegan and Constatin Ciuce

Reports 2024, 7(3), 74; https://doi.org/10.3390/reports7030074 - 3 Sep 2024

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Abstract

In the last few decades, obesity played a pivotal role by having a high impact on global economic and health systems due to its associated diseases, with cardiovascular, respiratory, musculoskeletal, oncological, mental, and social implications. One of the most incriminated physiopathological mechanisms in [...] Read more.

In the last few decades, obesity played a pivotal role by having a high impact on global economic and health systems due to its associated diseases, with cardiovascular, respiratory, musculoskeletal, oncological, mental, and social implications. One of the most incriminated physiopathological mechanisms in obesity is chronic inflammation. The primary goal of this pilot study was to determine the molecular aspects of inflammation among patients with obesity compared to participants with a normal BMI (≤25 kg/m²), as well as within a smaller subset of obese individuals who have been evaluated three months following sleeve gastrectomy. The research employs conventional blood tests and plasma measurements of particular molecules, such as proinflammatory cytokines and proteins that play critical roles in immune and inflammatory regulation. The results revealed a promising kinetic effect after bariatric surgery on IL-18, MCP-1, and PD-L1 molecules. The proinflammatory makers IL-18 (p = 0.006) and MCP-1 (p = 0.035) were elevated in the obese group compared to the control, while the follow-up group displayed lower levels of these molecules. Commonly investigated in oncology related studies, PD-L1 was recently linked to adipose tissue gain and its associated inflammatory effect. Until now, there is no clinical evidence for the relationship between circulating PD-L1 and proinflammatory markers derived from low-grade inflammation of the adipose tissue. The circulating PD-L1 levels were significantly lowered in the obese group compared to the control (p = 0.049), and after sleeve gastrectomy, the PD-L1 level increased. The present study is the first investigating this type of crosstalk and its potential involvement in bariatric patient management. Full article

(This article belongs to the Section Endocrinology/Metabolism)

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Heatmap of median differences between obese and control cohorts. The color gradient from blue to red represents the difference between the median values of the obese group and the control group for each variable. The median value was calculated for the obese group using the same method as for the control group, and further subtracted the control group’s median from the obese group’s median for each variable. Blue indicates a smaller or negative difference, while red indicates a larger or positive difference. Variables with tiles that are more towards red have a larger positive difference (the obese group has higher values), while variables with tiles that are more towards blue have a smaller or negative difference (the obese group has lower values). HDL—high density lipoprotein; BMI—body mass index; PDL1—programmed death-ligand 1; MCP1—monocyte chemoattractant protein-1; IL-18—interleukin 18; CRP—C-reactive protein; ALT—alanine aminotransferase/alanine transaminase. Full article ">Figure 2
Proinflammatory molecules and PD-L1 determinations—comparison between the three groups. Statistical evaluation was performed using GraphPad Prism (version 8) applying an unpaired two-tailed t-test with Welch’s correction, and the results are expressed as mean value ± SEM, * p < 0.05; ** p < 0.01. Full article ">Figure 3
Comparison of variables at baseline and follow-up, including all measured parameters. The upper panel displays box plots for each variable listed in the legend, which represents the interquartile range (IQR), which contains the middle 50% of the data. The line inside the box represents the median value. The lower panel shows bar plots for each variable. They represent the central tendency or the mean/median value for the baseline and follow-up measurements. Legend: 1. uric acid (mg/dL); 2. ALT (U/L); 3. albumin (g/dL); 4. AST (U/L); 5. total cholesterol (mg/dL); 6. creatinine (mg/dL); 7. CRP (mg/dL); 8. IL-18 (pg/mL); 9. IL-8 (pg/mL); 10. MCP-1 (pg/mL); 11. PD-L1 (pg/mL); 12. glucose (mg/dL); 13. HbA1c (%); 14. HDL (mg/dL); 15. hemoglobin (g/dL); 16. BMI (kg/m2); 17. LDL (mg/dL); 18. leukocytes (109/L); 19. lymphocytes (109/L); 20. monocytes (109/L); 21. neutrophils (109/L); 22. total proteins (g/dL); 23. iron (ug/dL); 24. triglycerides (mg/dL); 25. thrombocytes (109/L); 26. urea (mg/dL). Full article ">Figure 4
Correlation between hospital stay and PD-L1 and proinflammatory molecules. Full article ">

8 pages, 6002 KiB

Open AccessCase Report

Wandering Spleen Complicated by Thrombocytopenia, Acute Appendicitis, and Sepsis: A Case Report and Literature Review

by Sri Inggriani, Callistus Bruce Henfry Sulay and Gilbert Sterling Octavius

Reports 2024, 7(3), 73; https://doi.org/10.3390/reports7030073 - 2 Sep 2024

Viewed by 996

Abstract

Wandering spleen (WS) is a rare condition often linked with torsion or infarction, but its association with Bochdalek hernia, acute appendicitis, and thrombocytopenia is exceptionally rare. We present a case of a nine-year-old girl who was admitted with acute abdominal pain, later diagnosed [...] Read more.

Wandering spleen (WS) is a rare condition often linked with torsion or infarction, but its association with Bochdalek hernia, acute appendicitis, and thrombocytopenia is exceptionally rare. We present a case of a nine-year-old girl who was admitted with acute abdominal pain, later diagnosed with WS, Bochdalek hernia, and acute appendicitis. A literature search was performed on PubMed and Google Scholar on 30 May 2024 with keywords including “Wandering spleen” and (“Bochdalek Hernia” OR “Sepsis” OR “Acute Appendicitis” OR “Thrombocytopenia”). The management was complicated by severe thrombocytopenia and post-operative sepsis, with Klebsiella pneumoniae as the causative agent. Imaging revealed an abnormally located spleen and significant splenic enlargement over time. The patient’s condition was managed non-operatively concerning the WS, avoiding splenectomy due to the risks of post-splenectomy sepsis. Instead, laparotomy was performed to address the appendicitis and diaphragmatic hernia. The patient experienced post-operative complications, including a seizure and persistent fever, which resolved with appropriate antibiotic therapy. This case underscores the complexity of managing WS with concurrent severe conditions, highlighting the importance of individualised treatment strategies. It also emphasises the need for further studies to explore optimal treatment modalities for such rare and complex presentations. This case serves as an educational example in clinical settings, demonstrating the challenges and considerations when treating multiple rare pathologies simultaneously. Full article

(This article belongs to the Section Surgery)

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7 pages, 2020 KiB

Open AccessCase Report

Life-Threatening Hypokalemic Paralysis and Prevention of Severe Rebound Hyperkalemia in a Female with Barium Poisoning: A Rare Case Report

by Ting-Wei Liao, Ruei-Lin Wang, Szu-Chi Chen, Ya-Chieh Chang, Wen-Fang Chiang and Po-Jen Hsiao

Reports 2024, 7(3), 72; https://doi.org/10.3390/reports7030072 - 28 Aug 2024

Viewed by 1070

Abstract

Hypokalemic paralysis is a clinical syndrome characterized by acute flaccid paralysis with concomitant hypokalemia. Complications, such as acute respiratory failure and cardiac arrhythmias, can be fatal. If treated appropriately, the patient can recover without any sequelae. We present a rare case of life-threatening [...] Read more.

Hypokalemic paralysis is a clinical syndrome characterized by acute flaccid paralysis with concomitant hypokalemia. Complications, such as acute respiratory failure and cardiac arrhythmias, can be fatal. If treated appropriately, the patient can recover without any sequelae. We present a rare case of life-threatening hypokalemic paralysis following the ingestion of an unknown substance. At presentation, her serum potassium concentration was 1.9 mmol/L. A review of the patient’s history confirmed the ingestion of barium chloride. She was diagnosed with acute barium poisoning characterized by high serum and urine barium levels. Aggressive potassium repletion was administered intravenously and orally. Her serum potassium concentration dropped to 1.5 mmol/L and peaked at 5.4 mmol/L following treatment. The patient achieved a complete recovery and was discharged without sequelae. Barium can competitively block the potassium inward rectifier channels and interfere with the efflux of intracellular potassium, leading to severe hypokalemia. Our report illustrates a rare presentation of acute barium intoxication and a differential diagnosis indicating hypokalemic paralysis. We also discuss the pathophysiological features and compare the clinical findings with cases of rebound hyperkalemia. Full article

(This article belongs to the Section Critical Care/Emergency Medicine/Pulmonary)

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12 pages, 2138 KiB

Open AccessArticle

Assessing the Methylation Status of Two Potential Key Factors Involved in Cervical Oncogenesis

by Alina Fudulu, Marinela Bostan, Iulia Virginia Iancu, Adriana Pleșa, Adrian Albulescu, Irina Liviana Stoian, Demetra Gabriela Socolov, Gabriela Anton and Anca Botezatu

Reports 2024, 7(3), 71; https://doi.org/10.3390/reports7030071 - 18 Aug 2024

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Abstract

(1) Background: Cervical cancer, caused mainly by high-risk Human Papillomavirus (hrHPV), is a significant global health issue. While a Pap smear remains a reliable method for early detection, identifying new biomarkers to stratify the risk is crucial. For this purpose, extensive research has [...] Read more.

(1) Background: Cervical cancer, caused mainly by high-risk Human Papillomavirus (hrHPV), is a significant global health issue. While a Pap smear remains a reliable method for early detection, identifying new biomarkers to stratify the risk is crucial. For this purpose, extensive research has been conducted on detecting DNA methylation. (2) Methods: This cross-sectional study aimed to assess the expression levels of EIF4G3 and SF3B1 in precursor lesions and cervical tumor tissues through qRT-PCR and evaluate the methylation status of their promoters through bisulfite conversion. (3) Results: Both genes showed similar mRNA expression patterns, with the highest levels observed in squamous cell carcinoma (SCC) samples (p < 0.0001). Additionally, methylation analysis indicated increased percentages in the control group for both factors. Notably, the expression levels of both genes were inversely correlated with promoter methylation (EIF4G3—p = 0.0016; SF3B1—p < 0.0001). (4) Conclusions: Regarding the methylation pattern for both genes, we observe a decreasing trend from NILM to SCC patients. Therefore, we concluded that the decrease in methylation at the promoter level for both genes could be an indicator of abnormal cytology. Full article

(This article belongs to the Topic Cancer Stem Cells, DNA Methylation and DNA Sequences: Their Diagnostic and Therapeutical Applications)

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7 pages, 2290 KiB

Open AccessCase Report

Is Minimal Change Disease Associated with Prostate Cancer or Is Age Just a Number?

by Patrícia Kleinová, Matej Vnučák, Karol Graňák, Monika Beliančinová, Tímea Blichová and Ivana Dedinská

Reports 2024, 7(3), 70; https://doi.org/10.3390/reports7030070 - 13 Aug 2024

Viewed by 950

Abstract

Background: Prostate cancer is the most common malignancy in men. Secondary nephrotic syndrome, a feature of paraneoplastic syndrome, occurs in 11% of cases and is mainly caused by membranous glomerulopathy. The association between minimal change disease and prostate cancer is rare. Only one [...] Read more.

Background: Prostate cancer is the most common malignancy in men. Secondary nephrotic syndrome, a feature of paraneoplastic syndrome, occurs in 11% of cases and is mainly caused by membranous glomerulopathy. The association between minimal change disease and prostate cancer is rare. Only one cause has been described in the available literature. Case presentation: We present the case of a 77-year-old patient who was admitted to our department with stage 3 acute kidney injury and with nephrotic syndrome with anasarca (creatinine: 168 µmol/L, eGFR: 33 mL/min/1.73 m², albumin: 18.5 g/L, total cholesterol: 6.86 mmol/L, urine albumin creatinine ratio: 812.7 mg/mmol). In the differential diagnosis of nephrotic syndrome, looking for a secondary cause is essential, so the parainfectious causes of nephrotic syndrome were excluded. An elevated prostate-specific antigen (10.69 ng/L) was found when screening for oncological causes, and prostate adenocarcinoma was identified on biopsy. A renal biopsy was then performed with a finding of minimal change disease. Despite the generally accepted guidelines of prostate carcinoma in that stage and age of the patient being watchful waiting, antiandrogen therapy was started with the cooperation of a urologist. There was a significant improvement in renal parameters in the patient (creatinine: 87 µmol/L, eGFR: 73 mL/min/1.73 m², albumin: 33.4 g/L, urine albumin creatinine ratio: 27.6 mg/mmol). Conclusion: This case shows the importance of multidisciplinary cooperation in the treatment of secondary causes of nephrotic syndrome. In the case of proven paraneoplastic syndrome, it is necessary to start treating the malignancy; however, in general, a conservative approach without treatment is recommended. Full article

(This article belongs to the Section Nephrology/Urology)

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Figure 1
Histological examination of renal biopsy. (a) Light microscopy with periodic acid-methenamine silver staining (magnification ×100): no changes in the glomerular basal membrane; (b) light microscopy with haematoxylin eosin staining (magnification ×400): no changes are observed in the glomeruli; (c) electron microscopy (magnification ×5000): extensive foot processes effacement (red arrows), no electron dense deposits or segmental sclerosis, and normal glomerular basement membrane thickness. Full article ">Figure 2
Histological examination of prostate biopsy. (a) H&E staining (magnification ×100): adenocarcinoma formed by a mixture of glands with a preserved lumen (Gleason growth pattern 3) and glands with an indistinct, minimally marked lumen (Gleason growth pattern 4). (b) H&E staining (magnification ×100): adenocarcinoma formed by the predominance of Gleason growth pattern 3 with minimal involvement of growth pattern 4: Gleason score 7 (3 + 4). Full article ">Figure 3
Clinical course before and after LHRH agonist and oral glucocorticoids administration; UACR—urine albumin/creatine ratio, LHRH—luteinising hormone-releasing hormone, CSs—corticosteroids. Full article ">Figure 4
The development of a prostate-specific antigen after LHRH agonist administrations; PSA—prostate-specific antigens, LHRH—luteinising hormone-releasing hormone. Full article ">

9 pages, 9789 KiB

Open AccessCase Report

CPR-Induced Life-Threatening Hemothorax in a Rescue PCI Patient: Case Report and Brief Challenges of Regional Centers

by Vaikunthan Thanabalasingam, Clement Tan, Chaminda Sella Kapu, Mark Daniel Higgins and Zhihua Zhang

Reports 2024, 7(3), 69; https://doi.org/10.3390/reports7030069 - 12 Aug 2024

Viewed by 838

Abstract

Background: Cardiopulmonary resuscitation (CPR) is performed in cardiac arrests. There exist life support guidelines for individuals in performing effective CPR. CPR-related bleeding and hemothoraces are rare. Intercostal artery rupture leading up to shock and respiratory compromise in such situations is rare. Here, we [...] Read more.

Background: Cardiopulmonary resuscitation (CPR) is performed in cardiac arrests. There exist life support guidelines for individuals in performing effective CPR. CPR-related bleeding and hemothoraces are rare. Intercostal artery rupture leading up to shock and respiratory compromise in such situations is rare. Here, we present a unique case with a management dilemma while discussing challenges and guidance to regional centers. Case presentation: A 49-year-old Caucasian male experienced an out-of-hospital cardiac arrest which required bystander cardiopulmonary resuscitation from a colleague prior to commencement of lysis protocol at the local hospital. Transfer was later arranged to the nearest cardiac catheterization laboratory where a rescue percutaneous coronary intervention was performed in the left anterior descending artery that required strict dual antiplatelet use. Beneath the shroud of these events was a life-threatening right-sided hemothorax from rupture of intercostal arteries that occurred during initial resuscitation. Astute recognition of this post-percutaneous coronary intervention resulted in eventual transfer of the patient to a tertiary center where the source and the collection of the bleed was addressed. The patient’s took a great trajectory to improvement. Conclusions: A regional center poses many challenges and limitations. Massive bleeding from intercostal arteries leading to hemorrhagic shock and respiratory compromise from an expanding hemothorax post-CPR is rare. Post-percutaneous coronary intervention use of dual antiplatelets posed a management dilemma that prompted assistance from tertiary counterparts. Clinicians should be astute and quick in assessing and providing care. Full article

(This article belongs to the Section Cardiology/Cardiovascular Medicine)

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AP erect CXR. Large biconvex right upper chest zone hyperdense lesion. Right lung and left upper lobe contain hazy air space opacity. No pneumothorax. No midline shift. Blunting of right costophrenic angle. Full article ">Figure 2
Multiphase CT scan with contrast of chest progressing from superior to inferior. Multiple bilateral rib fractures of 2nd to 6th ribs bilaterally. Moderate right-sided hematoma seen in posterior right extra-pleural space with contrast extravasation seen at the posterior right 3rd and 4th intercostal space suggestive of an active bleed. Right hemothorax. Anterosuperior mediastinal hemoatoma. Collapse consolidation in lung bases. Ground glass opacities with smooth septal thickening in both lung apices. Abdominal organs (not shown) are unremarkable. Full article ">Figure 3
Multiphase CT scan without contrast, arterial and delayed phases, progressing from superior to inferior, compared to previous CT. Increasing size of large right extra-pleural hematoma with multiple sites of active bleeding from intercostal arteries. Moderate-sized right hemothorax seemingly enlarging. Superior mediastinal and right chest wall hematoma. Full article ">Figure 4
Selective angiography of the right intercostal arteries and embolization of multiple areas of active bleeding with right femoral artery approach—active bleeding from several posterior intercostal arteries with significant right hemothorax. Right hemothorax progressed in size throughout duration of procedure, associated with mediastinal displacement to the left. Contrast extravasation noted from right third and fourth intercostal arteries laterally. Right first, second, third, and fourth posterior intercostal arteries have multiple areas of active bleeding. Particle embolization was performed using Spongostan particles to right first, second, third, fourth, sixth, and seventh intercostal arteries. Multiple detachable coils (measuring 2 mm to 5 mm in diameter) deployed within the bleeding intercostal arteries proximally. Full article ">Figure 5
Repeat CT with non-contrast of chest, progressing from superior to inferior. Right intrapleural hematoma increased in size relative to previous findings. New small left pleural effusion. Interstitial and alveolar pulmonary edema. Right lower lobe shows complete collapse. Moderate compressive atelectasis on right upper and middle lobe. Superior mediastinum shows mild hemorrhage. Full article ">Figure 6
Discharge CXR—nasogastric tube in situ. Persistent bands of atelectasis in right lower zone. Full article ">Figure 7
Case timeline of major events at each location, with the distance between each site listed. Full article ">

11 pages, 4542 KiB

Open AccessCase Report

Severe Bushmaster Snakebite Envenoming: Case Report and Overview

by Allan Quadros Garcês-Filho, Humberto H. M. Santos, Thays K. P. P. Aguiar, Dafnin L. S. Ramos, Luis E. B. Galan, Domingos S. M. Dantas, Felipe A. Cerni, Roberto C. Carbonell and Manuela B. Pucca

Reports 2024, 7(3), 68; https://doi.org/10.3390/reports7030068 - 7 Aug 2024

Viewed by 1052

Abstract

Unlike the well-documented bothropic and crotalid snakebites in Brazil, lachetic envenomings (i.e., triggered by the bushmaster snake) are rare and present significant diagnostic challenges. This case describes a severe envenoming induced by a Lachesis muta snake in a 26-year-old Brazilian man who was [...] Read more.

Unlike the well-documented bothropic and crotalid snakebites in Brazil, lachetic envenomings (i.e., triggered by the bushmaster snake) are rare and present significant diagnostic challenges. This case describes a severe envenoming induced by a Lachesis muta snake in a 26-year-old Brazilian man who was bitten near a forest in November 2022. Characteristic symptoms such as sweating and bradycardia pointed towards lachetic envenoming, but initial misdiagnosis as a bothropic bite resulted in a delay in appropriate antivenom therapy. Despite later receiving the correct treatment, the severity of the envenoming necessitated the amputation of a finger and triggered a severe infection. This report highlights the challenges of diagnosing and treating Lachesis spp. bites due to their rarity. Moreover, an overview of lachetic-induced signs and symptoms was explored. This study emphasizes that further reports are warranted to improve understanding of Lachesis muta envenoming and to optimize treatment strategies. Full article

(This article belongs to the Special Issue Venomous Encounters: Reports on Diagnoses, Management, Therapy, and Outcomes of Venomous Animal-Induced Envenomations)

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13 pages, 259 KiB

Open AccessArticle

Psychological and Psychiatric Characteristics of People with Keratoconus

by Szymon Florek, Piotr Gościniewicz, Magdalena Suszka, Ewa Mrukwa-Kominek and Robert Pudlo

Reports 2024, 7(3), 67; https://doi.org/10.3390/reports7030067 - 3 Aug 2024

Viewed by 790

Abstract

Background and Objectives: There are many reports in the literature on the co-occurrence of somatic diseases and psychiatric disorders. Relatively few have addressed the co-occurrence of corneal cone with anxiety, depression, or personality disorders. Materials and Methods: 99 patients with keratoconus [...] Read more.

Background and Objectives: There are many reports in the literature on the co-occurrence of somatic diseases and psychiatric disorders. Relatively few have addressed the co-occurrence of corneal cone with anxiety, depression, or personality disorders. Materials and Methods: 99 patients with keratoconus (study group) and 92 patients without keratoconus (control group) participated in the entire study, which was conducted in 2015 and 2020–2023. The Hamilton Depression Rating Scale (HDRS) and Beck’s Depression Inventory (BDI) were used to assess depressive symptoms, the State-Trait Anxiety Inventory (STAI) to assess anxiety symptoms, and the DSM-IV Personality Disorder Inventory (IBZO-DSM-IV) to identify personality disorders. Results: In the study group, the severity of depressive and anxiety symptoms correlated with all types of personality disorders. In the control group, these symptoms did not correlate with antisocial and narcissistic personalities. In the comparative analysis, there were more patients with antisocial, schizotypal, obsessive compulsive, schizoid, paranoid, and dependent personality traits in the study group. Conclusions: Patients with keratoconus have increased expressions of antisocial personality traits, but no differences in anxiety and depression symptoms were evident. Further research is needed among patients diagnosed with keratoconus in the short term. Full article

(This article belongs to the Section Mental Health)

15 pages, 1650 KiB

Open AccessArticle

Plasma CXCL4–DNA/RNA Complexes and Anti-CXCL4 Antibodies Modulation in an SSc Cohort under Iloprost Treatment

by Anna Mennella, Katia Stefanantoni, Raffaella Palazzo, Giuseppe Ocone, Immacolata Pietraforte, Simona Truglia, Ilaria Bisconti, Alba Pisacreta, Valeria Riccieri, Roberto Lande and Loredana Frasca

Reports 2024, 7(3), 66; https://doi.org/10.3390/reports7030066 - 2 Aug 2024

Viewed by 976

Abstract

Background: Systemic sclerosis (SSc) is an autoimmune disease characterized by vascular and immunity alterations and skin/internal organ fibrosis. Aberrant levels of plasma CXCL4, CXCL4–RNA/DNA complexes, type I IFN (IFN-I) and anti-CXCL4 antibodies characterize SSc. These parameters influence each other: CXCL4–self-DNA/RNA complexes are triggers [...] Read more.

Background: Systemic sclerosis (SSc) is an autoimmune disease characterized by vascular and immunity alterations and skin/internal organ fibrosis. Aberrant levels of plasma CXCL4, CXCL4–RNA/DNA complexes, type I IFN (IFN-I) and anti-CXCL4 antibodies characterize SSc. These parameters influence each other: CXCL4–self-DNA/RNA complexes are triggers of IFN-I in plasmacytoid dendritic cells (pDCs), and anti-CXCL4 autoantibodies amplify this effect. Here, we assess the modulation over time of plasma CXCL4 and the related parameters of CXCL4–DNA/RNA complexes, anti-CXCL4 antibodies, IFN-α and TNF-α in an SSc cohort under the synthetic analogue of prostacyclin PGI2 (iloprost) treatment to address contribution of these parameters to pathogenesis and their role as biomarkers. Methods: We analyzed immunological parameters at baseline (T0) and after 3 (T3) and 6 (T6) months in 30 SSc patients. Responders were the patients that lowered their disease activity parameters after six months of treatment. Results: Anti-CXCL4 autoantibodies correlated with both IFN-α and TNF-α levels in SSc plasma. Responders significantly down-regulated serum IFN-α. In seven patients with a shorter disease duration, improvement coincides with a decrease in plasma IFN-α, CXCL4 and TNF-α. Iloprost efficiently blocks pDCs IFN-α production induced by CXCL4–DNA/RNA complexes in vitro. Conclusions: The data suggest a possible role of iloprost as a disease-modifying drug, mainly accompanied by down-regulation of plasma IFN-I levels. Since CXCL4, IFN-I and TNF-α down-modulation was evident and significant in improving SSc patients with a shorter disease duration, these results warrant future investigations on the early use of iloprost to slow SSc progression. Full article

(This article belongs to the Section Allergy/Immunology)

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CXCL4-related parameters in the SSc plasma. IFN-α (a), ΤΝF−α (c), CXCL4 (b), immune complexes CXCL4–DNA (d) and CXCL4–RNA (e) and anti-CXCL4 (f) autoantibodies were determined by ELISA assay in SSc patients (N = 30) and healthy donors (HD, N = 17) before treatment (T0), at 3 months (T3) and 6 months (T6). Horizontal bars are the means; vertical bars are the standard error of the mean (SEM); p-values are calculated by paired Wilcoxon signed rank test. The mean plus 2 SD (standard deviation) of antibody reactivity or positivity for CXCL4–DNA or CXCL4–RNA of HD was used as cut-off (black line in panels (d–f)). Full article ">Figure 2
CXCL4-related parameters in responder SSc patients. Disease activity score (EScSGAI, (a)) and plasma IFN-α (b), CXCL4 (c) and TNF-α (d) were measured in responder patients (N = 16) at the time points in <a href="#reports-07-00066-f001" class="html-fig">Figure 1</a>. Data are plotted as mean plus standard error of the mean (SEM); p-values are calculated by paired Wilcoxon signed rank test. Full article ">Figure 3
CXCL4-related parameters in non-responder SSc patients. Disease activity score (EScSGAI, (a)) and plasma IFN-α (b), CXCL4 (c) and TNF-α (d) were measured in non-responder patients (N = 14) at the time points in <a href="#reports-07-00066-f001" class="html-fig">Figure 1</a>. Data are plotted as mean plus standard error of the mean (SEM); p-values are calculated by paired Wilcoxon signed rank test. Full article ">Figure 4
Principal component analysis plot of responder and non-responder SSc patients. Correlation circles of 7 variables and the first and second dimensions of responder patients (N = 16) at baseline (T0; 51% of the total variance explained) and at 6 months (T6; 48.5% of the total variance explained) and of non-responder subjects (N = 14) at baseline (T0; 63.5% of the total variance explained) and at 6 months (T6; 70.6% of the total variance explained). Full article ">Figure 5
Disease activity and CXCL4-related parameters in eaSSc patients. Disease activity score (EScSGAI, (a)) and plasma IFN-α (b), CXCL4 (c) and TNF-α (d) were measured in early patients (N = 7) at the indicated time points. Data are plotted as mean plus standard error of the mean (SEM); p-values are calculated by paired Wilcoxon signed rank test. Full article ">Figure 6
Disease activity and CXCL4-related parameters in the responders with long-lasting SSc. Disease activity score (EScSGAI, (a)) and plasma IFN-α (b), CXCL4 (c) and TNF-α (d) were measured in the responder patients (N = 9) with a disease duration > 5 years at the indicated time points. Data are plotted as mean plus standard error of the mean (SEM); p-values are calculated by paired Wilcoxon signed rank test. Full article ">Figure 7
Iloprost reduces TLR-triggered pDC-derived IFN-α in vitro. IFN-α released in the supernatant from healthy pDCs stimulated with immune complexes CXCL4–DNA (a) and CXCL4–RNA (b), or TLR7/8 ligand R848 (c) and TLR9 ligand CpGA (d) alone or in the presence of the indicated doses of iloprost at 24 h. IFN-α content was measured by ELISA assay. Horizontal bars are the means; vertical bars are the standard error of the mean (SEM); p-values are calculated by two-tailed Student’s t test for paired samples from 5–8 different donors. Full article ">

6 pages, 580 KiB

Open AccessCase Report

Social Isolation as a Precipitating Factor for Charles Bonnet Syndrome in a Patient with Mild Visual Deterioration

by Shriya Prakash Bhat, Abeezar Shipchandler and Chris Tokunaga

Reports 2024, 7(3), 65; https://doi.org/10.3390/reports7030065 - 2 Aug 2024

Viewed by 1043

Abstract

Charles Bonnet Syndrome (CBS) is characterized by complex visual hallucinations in individuals with acute vision loss, typically affecting older adults. Most CBS cases are observed in patients with sudden severe visual impairment; however, there are limited reports of CBS occurring in individuals with [...] Read more.

Charles Bonnet Syndrome (CBS) is characterized by complex visual hallucinations in individuals with acute vision loss, typically affecting older adults. Most CBS cases are observed in patients with sudden severe visual impairment; however, there are limited reports of CBS occurring in individuals with mild visual deterioration, particularly when confounded by sensory deprivation and social isolation. Here, we report a case of CBS in a female in her early 80s, who experienced vivid visual hallucinations during a period of prolonged social isolation following a hip surgery. Although symptomatology initially presented as delirium and psychosis, the diagnosis of CBS was confirmed after a neuropsychiatric evaluation and ophthalmologic exam, which showed mild deterioration in the patient’s macular degeneration, combined with a social history of reduced independence and increased isolation. The case highlights the lesser-known role of sudden lifestyle changes and reduced cognitive engagement in CBS development in cases of mild visual impairment. It also suggests that cognitive and social stimulation may play a crucial role in CBS management, which has limited reports in the current literature. Full article

(This article belongs to the Section Mental Health)

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11 pages, 1381 KiB

Open AccessArticle

Is It Necessary to Add the Feedback Insufflation Time in Manikins? A Simulation Pilot Study

by Luis Castro-Alonso, Eloy Carracedo-Rodríguez, Martín Otero-Agra, Sheila Vázquez-Álvarez, Roberto Barcala-Furelos and María Fernández-Méndez

Reports 2024, 7(3), 64; https://doi.org/10.3390/reports7030064 - 1 Aug 2024

Viewed by 730

Abstract

(1) Objective: This study aimed to assess the evolution of the quality of ventilations of a group of rescuers after two training sessions by taking into account inspiration times. (2) Materials and Methods: A pilot simulation study was carried out with a sample [...] Read more.

(1) Objective: This study aimed to assess the evolution of the quality of ventilations of a group of rescuers after two training sessions by taking into account inspiration times. (2) Materials and Methods: A pilot simulation study was carried out with a sample of 10 lifeguard students. Two training sessions were held three weeks apart, in which CPR skills were trained by means of feedback tools. Participants performed three tests in pairs on a ResusciAnne QCPR^® manikin connected to SkillReporter QCPR software, namely one pre-training test and one test after each training session. CPR was performed in pairs for two minutes and began with five rescue breaths. (3) Results: One training session was enough to improve chest compression quality (T0: 48%; IQR 17–77/T1: 83%; IQR 59–88; p = 0.022/T2: 79%; IQR 64–92; p = 0.002). The quality of the ventilations increased progressively in each training session without reaching high-quality results (T0: 0%; IQR 0–0/T2: 15%; IQR 8–27; p = 0.011). (4) Conclusion: A two-session training program focused on inspiratory times achieved significant improvements in the quality of bag-mask ventilations performed by lifeguard students. Training focused on the insufflation time of ventilations and not only on the volume seems to be an important factor in improving the quality of ventilations. Full article

(This article belongs to the Section Critical Care/Emergency Medicine/Pulmonary)

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6 pages, 2340 KiB

Open AccessCase Report

Multimodal Management of a Descending Aorta Injury with Penetrating Chest Trauma: A Case Report

by Giuseppe Sena, Paolo Perri, Paolo Piro, Francesco Zinno, Daniela Mazzuca, Davide Costa and Raffaele Serra

Reports 2024, 7(3), 63; https://doi.org/10.3390/reports7030063 - 1 Aug 2024

Viewed by 808

Abstract

A penetrating thoracic aorta injury (PTAI) is a life-threatening condition with significant morbidity and mortality, often resulting from several traumatic mechanisms. Among these, gunshot wounds leading to aortic injury are exceedingly rare and pose unique challenges in terms of diagnosis, management, and surgical [...] Read more.

A penetrating thoracic aorta injury (PTAI) is a life-threatening condition with significant morbidity and mortality, often resulting from several traumatic mechanisms. Among these, gunshot wounds leading to aortic injury are exceedingly rare and pose unique challenges in terms of diagnosis, management, and surgical intervention. We present a case of a 47-year-old male victim of a gunshot wound resulting in penetrating chest trauma and a descending thoracic aorta injury. This report outlines the sequential management involving thoracic endovascular aortic repair (TEVAR), followed by surgical intervention for hematoma drainage and foreign body removal, highlighting the interdisciplinary approach required in managing complex cardiothoracic injuries. Full article

(This article belongs to the Section Critical Care/Emergency Medicine/Pulmonary)

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10 pages, 30058 KiB

Open AccessCase Report

Optimization of Collagen Scaffold with Cultured Autologous Chondrocytes for Osteochondritis Dissecans of the Knee: A Case Report

by Nicolas Valladares, Gibran J. Jacobo-Jimenez, Nathaniel Lara-Palazuelos and Maria G. Zavala-Cerna

Reports 2024, 7(3), 62; https://doi.org/10.3390/reports7030062 - 30 Jul 2024

Viewed by 962

Abstract

The treatment of osteochondritis dissecans of the knee has always been a challenge for orthopedic surgeons. We present a case report of a 38-year-old male with severe right knee pain after suffering from an indirect trauma and axial rotation of the knee, limiting [...] Read more.

The treatment of osteochondritis dissecans of the knee has always been a challenge for orthopedic surgeons. We present a case report of a 38-year-old male with severe right knee pain after suffering from an indirect trauma and axial rotation of the knee, limiting knee functionality and impeding his ability to walk, with a diagnosis of osteochondritis dissecans in the trochlea of the knee, who underwent arthroscopic treatment with matrix-induced autologous chondrocyte implantation (MACI). After the surgery, a physical therapy protocol for MACI was implemented, and magnetic resonance images with cartilage mapping were used to evaluate the recovery of the lesion. A total recovery was observed and evaluated with the modified Cincinnati knee rating system (mCKRS). A discussion is provided with evidence and general recommendations for the use of MACI in the treatment of adult OCD of the knee as a possible alternative to conventional treatments. Our case shows a rapid improvement in pain and functionality 2 months after surgery that progressed to full recovery within 6 months. Full article

(This article belongs to the Special Issue Orthopedic and Trauma Surgery: Clinical Research and Case Reports)

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Patient timeline. Green boxes describe clinical findings, light yellow boxes represent imaging findings, dark yellow boxes describe the interventions performed on the patient, and the red box describes the outcome after 12 months of follow-up. Full article ">Figure 2
Initial knee MRI of the patient. (A) Axial T2 images of the MRI of the right knee, in which a subchondral lesion is noted on a second look after the surgery, directed by the surgical macroscopic observed lesions; a subchondral lesion is noted at the trochlea (arrow tip); (B) digital T2 map filter showing the appearance of a disruption of the cartilage (arrow). Full article ">Figure 3
First surgical intervention. (A) Arthroscopic vision where the osteochondral lesion on the trochlea is visible, affecting both cartilage and subchondral bone; (B) macroscopic image of the free chondral body, which has the same dimensions as the osteochondral lesion on the femoral trochlea. Full article ">Figure 4
Second surgical intervention. (A) Arthroscopic vision of the size of the sample taken for chondrocyte culture (arthroscopic probe for reference); (B) macroscopic vision of the sample taken for chondrocyte culture; (C) sample transferred into a tube with serum-free transport medium to be sent for chondrocyte culture. Full article ">Figure 5
Evolution of chondrocyte culture. (A) Chondrocyte culture 3 days after enzymatic digestion. (B) Second passage of the cultured chondrocytes, with the addition of fresh cultured media enriched with 10% fetal bovine serum. (C) After several days of condensation of the second passage, chondrocytes became packed, acquired a stacked appearance, and could be added to the scaffold. Cell viability was routinely tested. Photographs were taken with an Optika IM-3 inverted microscope (10×), observed in bright field without staining. Full article ">Figure 6
(A) Arthroscopic vision of the femoral trochlea with debridement of the subchondral bone. (B) Arthroscopic application of the matrix to fill the femoral defect. (C) Matrix in place with addition of a fibrin gel (Tissucol) for implant stabilization. Full article ">Figure 7
A 3-Tesla control MRI of the right knee 6 months after the surgical procedure. (A) T1 axial image with measurement of the cartilage in the site of MACI, with normal appearance and length. (B) Cartilage measurements at the site of the implant in comparison with the rest of the trochlea, with consistency throughout. Full article ">

11 pages, 958 KiB

Open AccessArticle

Association of SARS-CoV-2 Seropositivity with Persistent Immune Activation in HIV/Tuberculosis Co-Infected Patients

by Ashwini Shete, Manisha Ghate, Hiroko Iwasaki-Hozumi, Sandip Patil, Pallavi Shidhaye, Takashi Matsuba, Gaowa Bai, Pratiksha Pharande and Toshio Hattori

Reports 2024, 7(3), 61; https://doi.org/10.3390/reports7030061 - 29 Jul 2024

Viewed by 1321

Abstract

We asked if SARS-CoV-2 seropositivity in HIV/TB co-infected patients plays a role in precipitating active tuberculosis in HIV-infected individuals and alters inflammatory status. A prospective study was conducted on HIV/TB co-infected patients presenting with pulmonary (n = 20) or extrapulmonary (n [...] Read more.

We asked if SARS-CoV-2 seropositivity in HIV/TB co-infected patients plays a role in precipitating active tuberculosis in HIV-infected individuals and alters inflammatory status. A prospective study was conducted on HIV/TB co-infected patients presenting with pulmonary (n = 20) or extrapulmonary (n = 12) tuberculosis. Abbott SARS-CoV-2 IgG kits assessed the presence of anti-nucleoprotein antibodies. Inflammatory markers viz. osteopontin, total and full-length galectin-9, and C-reactive protein were tested at baseline and the end of antituberculosis treatment. The inflammatory score (INS) was assessed based on the percentage of reduction in the inflammatory markers’ levels at the end of the treatment. Anti-SARS-CoV-2 antibodies were detected in five male patients diagnosed with pulmonary (n = 2) and extrapulmonary (n = 3) TB. None of them reported symptomatic COVID-19. Inflammatory marker levels did not differ significantly at baseline compared to those in seronegative patients. However, the INS correlated negatively with SARS-CoV-2 seropositivity (r = −0.386, p = 0.039), indicating persistently raised inflammatory markers in these patients at the end of the treatment compared to seronegative individuals. Among the four markers studied, total galectin-9 levels failed to decrease significantly in these patients (p = 0.030). The majority of HIV/TB co-infected patients enrolled in our study (84.5%) were SARS-CoV-2-seronegative, indicating that SARS-CoV-2 infection might not have played a role in precipitating TB reactivation. Full article

(This article belongs to the Special Issue Acute and Persistent Viral Infection Diseases)

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12 pages, 1819 KiB

Open AccessArticle

Diagnosis of Relapse of Colorectal Adenocarcinoma through CEA Fluctuation

by Zsolt Fekete, Patricia Ignat, Laura Gligor, Nicolae Todor, Alina-Simona Muntean, Alexandra Gherman and Dan Eniu

Reports 2024, 7(3), 60; https://doi.org/10.3390/reports7030060 - 27 Jul 2024

Viewed by 1492

Abstract

Carcinoembryonic antigen(CEA) is a routine marker employed for follow-up of colorectal tumors. We aimed to determine whether a CEA increase within the normal range can be linked to a risk of recurrence. From the period of 2006–2013 we selected 78 consecutive patients with [...] Read more.

Carcinoembryonic antigen(CEA) is a routine marker employed for follow-up of colorectal tumors. We aimed to determine whether a CEA increase within the normal range can be linked to a risk of recurrence. From the period of 2006–2013 we selected 78 consecutive patients with colorectal cancer, who underwent curative surgery with or without neo-/adjuvant chemo- or radiotherapy and had proper follow-up procedures. For analyzing CEA fluctuation, we used the smallest value of the CEA during follow-up as the reference. With the aid of a Chi-squared test, we have chosen the value of 1.1 ng/mL for significant CEA fluctuation. A total of 43.6% of patients had fluctuations in CEA of at least 1.1 ng/mL, with or without increases above 5 ng/mL. From these, in 79.4% of patients, the increases in CEA were explained either by recurrence (44.1%), adjuvant chemotherapy (20.6%) or benign pathology (14.7%). In 23% of the recurrences, a CEA increase of at least 1.1 ng/mL, but below 5 ng/mL, preceded the clinical relapse by a median of 8 months. Our conclusion is that an increase in CEA levels by at least 1.1 ng/mL within the normal range after curative treatment for colorectal cancer may serve as an early indicator of relapse or could be associated with other pathological conditions. Full article

(This article belongs to the Collection Clinical Research in Oncology)

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4 pages, 1505 KiB

Open AccessCase Report

Popliteal Arteriovenous Fistula Diagnosed Eight Years after Total Knee Arthroplasty. Endovascular Treatment with Viabahn^® Endoprosthesis and Five-Year Follow-Up

by Francisco Santiago Lozano-Sánchez, Jesús García-Alonso, Roberto Salvador-Calvo, Luis Velasco-Pelayo and María Begoña García-Cenador

Reports 2024, 7(3), 59; https://doi.org/10.3390/reports7030059 - 25 Jul 2024

Viewed by 712

Abstract

Background: Orthopedic surgery, while it rarely cause iatrogenic vascular lesions, leads to significant clinical, social, and economic consequences when it does. The knee is particularly susceptible to these injuries. Case Description: This case study presents the clinical case of a 71-year-old woman with [...] Read more.

Background: Orthopedic surgery, while it rarely cause iatrogenic vascular lesions, leads to significant clinical, social, and economic consequences when it does. The knee is particularly susceptible to these injuries. Case Description: This case study presents the clinical case of a 71-year-old woman with a history of left total knee replacement. Eight years after the initial procedure, a popliteal—popliteal arteriovenous fistula was identified in the same knee. Given the location and caliber of the fistula, and despite the absence of symptoms, an endovascular prosthesis (Viabahn^®) was deployed in the popliteal artery to cover the fistula. The prosthesis remained intact for the remainder of the patient’s life, who succumbed to metastatic cancer five years later. Additionally, a review of the literature was conducted. Conclusion: This brief report describes an exceptional case of popliteal arteriovenous fistula, diagnosed eight years after a TKA, treated endovascularly and followed up over five years. Both pseudoaneurysms and arteriovenous fistulae should also be considered for early detection. Full article

(This article belongs to the Section Cardiology/Cardiovascular Medicine)

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7 pages, 3171 KiB

Open AccessCase Report

Myxolipoma of the Popliteal Fossa: A Rare Tumor Case Report

by Yuchen You, Jessica Cao, Brandon Nguyen, Melanie Gero and Karim Jreije

Reports 2024, 7(3), 58; https://doi.org/10.3390/reports7030058 - 25 Jul 2024

Viewed by 1221

Abstract

Myxolipomas are rare variants of lipomas characterized by abundant myxoid changes resulting from an abundant mucoid component. While myxolipomas have been reported in various anatomical locations, their occurrence in the popliteal fossa is exceptionally rare, with the last published case dating back to [...] Read more.

Myxolipomas are rare variants of lipomas characterized by abundant myxoid changes resulting from an abundant mucoid component. While myxolipomas have been reported in various anatomical locations, their occurrence in the popliteal fossa is exceptionally rare, with the last published case dating back to 1914. We present a case of a 64-year-old male with a large myxolipoma in the popliteal region. The patient underwent successful surgical excision, and a histopathological examination confirmed the diagnosis of myxolipoma. This case report highlights the clinical features, differential diagnosis, and diagnostic challenges associated with myxolipomas in the popliteal fossa. Full article

(This article belongs to the Section Oncology)

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10 pages, 1207 KiB

Open AccessCase Report

The Effects of Hybrid Tele Airway Clearance in Bronchiectasis Patients: A Case Series

by Aung Aung Nwe, Nimit Kosura, Chatchai Phimphasak, Pornthip Barnludech, Si Thu Aung, Worawat Chumpangern and Chulee Ubolsakka-Jones

Reports 2024, 7(3), 57; https://doi.org/10.3390/reports7030057 - 19 Jul 2024

Viewed by 1000

Abstract

This study aims to evaluate the preliminary effects of a hybrid tele-supervised airway clearance protocol on secretion clearance, health-related quality of life, and patient satisfaction in bronchiectasis patients. A single-arm experimental pilot case series with three participants was conducted, involving six ACT sessions [...] Read more.

This study aims to evaluate the preliminary effects of a hybrid tele-supervised airway clearance protocol on secretion clearance, health-related quality of life, and patient satisfaction in bronchiectasis patients. A single-arm experimental pilot case series with three participants was conducted, involving six ACT sessions over three days, including one onsite supervised session and five tele-supervised sessions. Assessment measures comprised sputum expectoration, COPD assessment test (CAT), and participant satisfaction ratings. The results showed increased sputum expectoration rates during each ACT session, alongside notable improvements in CAT scores (reductions of 16, 8, and 8 points for each participant). Participants expressed high satisfaction with tele-supervised sessions and reported increased confidence in independent ACT performance post-program. The findings suggest that the hybrid ACT program may be a promising avenue for enhancing bronchiectasis management. However, further research with larger sample sizes and rigorous control groups is necessary to validate its efficacy and broader applicability. Full article

(This article belongs to the Section Orthopaedics/Rehabilitation/Physical Therapy)

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5 pages, 865 KiB

Open AccessCase Report

Intradural Melanotic Schwannoma of the Sacral Spine: An Illustrated Case Report of Diagnostic Conundrum

by Jiunn-Kai Chong, Navneet Kumar Dubey and Wen-Cheng Lo

Reports 2024, 7(3), 56; https://doi.org/10.3390/reports7030056 - 16 Jul 2024

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Abstract

Schwannomas are benign and slow-growing peripheral nerve sheath neoplasms of Schwann cells. These are generally encountered in the neck, head, and flexor areas of the extremities. Even though many schwannomas are easily diagnosable, their variable morphology can occasionally create difficulty in diagnosis. In [...] Read more.

Schwannomas are benign and slow-growing peripheral nerve sheath neoplasms of Schwann cells. These are generally encountered in the neck, head, and flexor areas of the extremities. Even though many schwannomas are easily diagnosable, their variable morphology can occasionally create difficulty in diagnosis. In this study, we present a rare case of melanotic schwannoma of the sacrum, emphasizing the need for routine biopsy to understand the etiology. A 46-year-old man presented to the Department of Neurosurgery, Taipei Medical University Hospital, with buttock pain in the sacrum area for 1 year, which worsened in the last 1–2 months. The patient had no known history of trauma or malignancy. We evidenced an intradural extramedullary neurogenic tumor at the caudal end from S1 to S3. Histologic analysis revealed melanin deposition in the tumor cells. Round to oval tumor cells were positive for HMB-45 and S-100 proteins, suggestive of melanotic Schwannoma, which were removed by laminectomy. After 1 month, the tumor recurred and was further removed surgically. Conclusively, we observed the sacrum as an unusual anatomic site for the possible occurrence of melanotic schwannoma, especially in patients with no known history of trauma and malignancy. The possibility of melanotic schwannoma is very high. We hypothesize that melanotic schwannoma was possible because it occurred in the intradural and extramedullary regions of the spine. Hence, a routine biopsy should be performed to corroborate the exact cause and prevent incorrect presumptions. Full article

(This article belongs to the Section Neurology)

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7 pages, 5123 KiB

Open AccessCase Report

Concurrent Onset of Central Retinal Vein Occlusion and Inflammation of a Large Maxillary Odontogenic Cyst: Case Report and Analysis

by Vlatko Kopić, Andrijana Kopić, Mihael Mišir and Sanjin Petrović

Reports 2024, 7(3), 55; https://doi.org/10.3390/reports7030055 - 14 Jul 2024

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Abstract

Central retinal vein occlusion typically manifests in older individuals with underlying systemic pathology, leading to a spectrum of symptoms ranging from blurred vision to complete vision loss. While odontogenic infections are recognized for causing complications affecting the eye and vision, their potential role [...] Read more.

Central retinal vein occlusion typically manifests in older individuals with underlying systemic pathology, leading to a spectrum of symptoms ranging from blurred vision to complete vision loss. While odontogenic infections are recognized for causing complications affecting the eye and vision, their potential role as an etiological factor in cases of sudden vision impairment merits consideration. This article presents a case involving central retinal vein thrombosis, wherein resolution was achieved through a combination of ophthalmic therapy and the surgical removal of a concurrently existing large inflamed odontogenic cyst located in the ipsilateral hemimaxilla. This case underscores the importance of recognizing odontogenic factors in the assessment of sudden vision impairment and the efficacy of a multidisciplinary therapeutic approach. Full article

(This article belongs to the Special Issue Clinical Research on Oral Diseases)

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7 pages, 207 KiB

Open AccessCase Report

Anisometropic Patient and Current Bioelectrical Activity in the Masticatory and Cervical Muscles

by Grzegorz Zieliński, Anna Woźniak, Michał Ginszt, Jacek Szkutnik, Nicola Marchili, Marcin G. Prost, Piotr Gawda and Robert Rejdak

Reports 2024, 7(3), 54; https://doi.org/10.3390/reports7030054 - 10 Jul 2024

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Abstract

(1) Background: This study aims to analyze the bioelectrical activity of the masticatory and cervical muscles in a subject with anisometropia. (2) Methods: A female patient aged 23 years with a best-corrected visual acuity of 1.0 in the right eye and 0.1 in [...] Read more.

(1) Background: This study aims to analyze the bioelectrical activity of the masticatory and cervical muscles in a subject with anisometropia. (2) Methods: A female patient aged 23 years with a best-corrected visual acuity of 1.0 in the right eye and 0.1 in the left eye, a refractive error of −2.25 Dsph in the right eye and +4.25 Dsph in the left eye, and astigmatism of −1.75 Dcyl axis 24° was examined. A comprehensive ophthalmological examination and the study of the bioelectrical activity of the muscles were carried out. During the ophthalmological examination, best-corrected visual acuity was determined, refractive error (spherical equivalent) was assessed, and additionally, retinal thickness, choroidal thickness, axial length, and intraocular pressure were measured. (3) Results: It was demonstrated that higher tension in the resting mandibular position and pain-free maximum unassisted opening were observed on the right side (myopia). Conversely, higher tension during maximum voluntary clenching in the intercuspal position and maximum voluntary clenching on dental cotton rolls in the intercuspal position was observed on the left side (hyperopia and astigmatism). (4) Conclusions: In the case study, muscle asymmetry was demonstrated, which is likely associated with anisometropia. This phenomenon requires further investigation. Full article

(This article belongs to the Section Ophthalmology)

8 pages, 2852 KiB

Open AccessCase Report

ADEM as an Initial Presentation of SLE: A Case Report

by Yousuf Sherwani, Ayham Alsaab and Mohan Sengodan

Reports 2024, 7(3), 53; https://doi.org/10.3390/reports7030053 - 5 Jul 2024

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Abstract

Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disorder of the white matter. The pathophysiology is thought to be immune-mediated as in most cases the condition follows an infection or triggering incident. More recent literature has demonstrated that there may be a link [...] Read more.

Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disorder of the white matter. The pathophysiology is thought to be immune-mediated as in most cases the condition follows an infection or triggering incident. More recent literature has demonstrated that there may be a link between autoimmune conditions and ADEM. Here we present a case of ADEM in a middle-aged woman with systemic lupus erythematosus that recovered well after treatment with corticosteroids and rituximab. Full article

(This article belongs to the Section Allergy/Immunology)

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11 pages, 1142 KiB

Open AccessArticle

Factors Influencing Abdominal Compliance during CO₂ Insufflation in Patients Undergoing Laparoscopic Abdominal Surgery

by Ezgi Yıldırım, K. Sanem Cakar Turhan, Aysegul Güven, Derya Gökmen and Menekse Özcelik

Reports 2024, 7(3), 52; https://doi.org/10.3390/reports7030052 - 28 Jun 2024

Cited by 1 | Viewed by 1172

Abstract

The aim of this study was to investigate the effect of patient demographic and anatomical characteristics on abdominal compliance (AC), which represents the slope of the pressure–volume (P–V) curve of the abdominal cavity and is a measure of the ease of abdominal dilatation. [...] Read more.

The aim of this study was to investigate the effect of patient demographic and anatomical characteristics on abdominal compliance (AC), which represents the slope of the pressure–volume (P–V) curve of the abdominal cavity and is a measure of the ease of abdominal dilatation. The study included 90 patients undergoing laparoscopic abdominal surgery. Subcutaneous adipose tissue and abdominal muscle thickness were measured using ultrasonography. The mean AC was calculated during insufflation using the formula (ΔV/ΔP). The relationship between demographic and anatomical variables and AC was investigated. The results demonstrated that AC was higher in men, the elderly, and women with a history of pregnancy, and lower in patients with a history of abdominal surgery. No significant correlation was found between AC and BMI, abdominal muscle thickness, and subcutaneous adipose tissue thickness. These findings suggest that morbid obesity, a common comorbidity in laparoscopic surgery, and well-developed abdominal muscles are not indicators of low AC. However, gender, age, pregnancy history, and previous abdominal surgery affect AC during laparoscopic surgery. By taking these factors into account during preoperative evaluation, it may be possible to predict patients with low AC, which could improve perioperative outcomes through the application of individualized intra-abdominal pressure (IAP) during pneumoperitoneum. Full article

(This article belongs to the Section Surgery)

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6 pages, 3804 KiB

Open AccessInteresting Images

Gingival Cyst of the Adult: A Case Description with a Relevant Literature Analysis

by Marta Forte, Antonio d’Amati, Alfonso Manfuso, Massimiliano Vittoli, Giorgia Girone, Eliano Cascardi and Saverio Capodiferro

Reports 2024, 7(3), 51; https://doi.org/10.3390/reports7030051 - 24 Jun 2024

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Abstract

Gingival cysts of the adult are rare and benign odontogenic lesions of the oral cavity, accounting for almost 0.3% of all odontogenic cysts. Their differential diagnosis is still challenging for surgeons as it includes other gingival inflammatory or non-inflammatory lesions and peripheral odontogenic [...] Read more.

Gingival cysts of the adult are rare and benign odontogenic lesions of the oral cavity, accounting for almost 0.3% of all odontogenic cysts. Their differential diagnosis is still challenging for surgeons as it includes other gingival inflammatory or non-inflammatory lesions and peripheral odontogenic tumors. The aim of this paper is to report a new case occurring in an adult, analyzing the clinical, radiographic, and histopathological features as guidelines for a differential diagnosis. We report a 49-year-old patient complaining of a small, pigmented lesion localized on the attached gingiva with no history of trauma, which was surgically excised and histologically diagnosed as a gingival cyst. A differential diagnosis may be challenging for clinicians it includes a wide spectrum of inflammatory and non-inflammatory lesions, so a correct diagnostical–therapeutical approach is needed to avoid possible overtreatment and minimize the recurrence rate. Full article

(This article belongs to the Special Issue Clinical Research on Oral Diseases)

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Reports, Volume 7, Issue 3 (September 2024) – 31 articles

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